Neurology and.
J Neurosurg. 2014 Jan;120(1):178-84. doi: 10.3171/2013.8.JNS13575. Epub 2013 Sep 27.
Different neuroimaging biomarkers have been studied to find a tool for prediction of response to CSF shunting in idiopathic normal-pressure hydrocephalus (iNPH). The callosal angle (CA) has been described as useful in discriminating iNPH from ventricular dilation secondary to atrophy. However, the usefulness of the CA as a prognostic tool for the selection of shunt candidates among patients with iNPH is unclear. The aim of this study was to compare the CA in shunt responders with that in nonresponders and clarify whether the CA can serve as a predictor of the outcome.
Preoperative MRI brain scans were evaluated in 109 patients who had undergone shunt surgery for iNPH during 2006-2010. Multiplanar reconstruction was performed interactively to obtain a coronal image through the posterior commissure, perpendicular to the anterior-posterior commissure plane. The CA was measured as the angle between the lateral ventricles on the coronal image. The patients were examined clinically before surgery and at 12 months postoperatively.
Shunt responders had a significantly smaller mean preoperative CA compared with nonresponders: 59° (95% CI 56°-63°) versus 68° (95% CI 61°-75°) (p < 0.05). A CA cutoff value of 63° showed the best prognostic accuracy.
The preoperative CA is smaller in patients whose condition improves after shunt surgery and may be a useful tool in the selection of shunt candidates among patients with iNPH.
已有多种神经影像学生物标志物被研究用于预测特发性正常压力脑积水（iNPH）患者对脑脊液分流的反应。胼胝体角（CA）已被描述为一种有用的工具，可用于区分 iNPH 与因萎缩导致的脑室扩张。然而，CA 作为 iNPH 患者分流候选者选择的预后工具的有用性尚不清楚。本研究旨在比较分流反应者和非反应者的 CA，并阐明 CA 是否可以作为预测结果的指标。
对 2006 年至 2010 年间因 iNPH 接受分流手术的 109 例患者的术前 MRI 脑扫描进行评估。通过交互式多层面重建获得通过后连合的冠状图像，与前后连合平面垂直。在冠状图像上测量 CA 作为侧脑室之间的角度。患者在术前和术后 12 个月进行临床检查。
分流反应者的术前 CA 平均值明显小于非反应者：59°（95%CI 56°-63°）与 68°（95%CI 61°-75°）（p<0.05）。CA 截断值为 63°时具有最佳的预后准确性。
分流手术后病情改善的患者的术前 CA 较小，可能是 iNPH 患者中选择分流候选者的有用工具。
